IBS Archives - Granite Peaks Gastroenterology of Utah

Belching, Bloating, and Flatulence

Posted on June 9, 2022June 9, 2022 by May Marschner

We know it’s embarrassing when your digestive symptoms become noticeable to others. There can be many causes for the belching, bloating and flatulence that you may experience and your gastroenterologist can help you find the culprit that is interrupting your life. Read on to learn more.

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Symptoms and Possible Causes

Conditions That May Cause Symptoms

Diagnosing Your Symptoms

Option to Rule Out Dietary Influences

Originally posted on 4/10/2018
Updated on 6/9/2022

Belching, bloating, and flatulence: Any of these symptoms can be embarrassing, leading to unwanted noises, abdominal discomfort, and general malaise. Occasionally experiencing these symptoms is normal, but if symptoms become excessive or too frequent, they can negatively impact your life.

Symptoms and Possible Causes

Belching occurs when excess air is swallowed, causing the stomach to become too full. Flatulence may be a result of this swallowed air, or it can be caused by gas produced by bacteria in the colon. Bloating is a feeling of fullness in the upper abdomen that may be caused by gas in the stomach or intestines.

Issues that can lead to swallowing excess air:
• Simply eating food
• Chewing gum
• Carbonated beverages
• Experiencing anxiety
• Poorly-fitting dentures
• Postnasal drip

Excess intestinal gas can be caused by:
• Gas-producing foods such as cabbage, cauliflower, broccoli, and beans
• Bran and other high-fiber cereals
• Dairy products including milk, some cheeses, and ice cream – especially those dairy products that lack the enzyme lactase, which is necessary to digest milk sugars
• Bacterial overgrowth – normal bacteria in the gut that produce intestinal gas

Carbohydrates that are not digested well in the small intestine travel to the colon where they are metabolized by bacteria into hydrogen and carbon dioxide gases. This causes cramping, bloating, and flatulence. In some people, these gases can accumulate in the right upper section of the colon, leading to pain similar to gallbladder pain. Gas accumulated in the left upper section of the colon can cause chest pain that feels like a cardiac episode.

Conditions That May Cause These Symptoms

• Those suffering from Irritable Bowel Syndrome (IBS) can be extremely sensitive to increased intestinal gases.
• Patients with altered anatomy from surgical changes or with poor intestinal motility can be at increased risk of bacterial overgrowth, leading to excess gas.
• If postnasal drip is suspected, your doctor may check for sinus problems.

Diagnosing for Belching, Bloating and Flatulence:

Our Granite Peaks Gastroenterology Specialists will meet with you to discuss your symptoms and determine what tests may be needed. They may recommend an upper endoscopy, depending on the frequency, severity, and location of your symptoms. If celiac disease is suspected, this may be detected during an upper endoscopy. If bacterial overgrowth is a possibility, it may be diagnosed with a breath test.

Some Options to Rule Out Dietary Influences:

• Withdraw dairy products from the diet to rule out lactose intolerance
• Eliminate carbonated beverages from the diet
• Eliminate gas-producing foods such as cauliflower, cabbage, broccoli, beans, and bran from the diet—eliminate these ones by one and keep a diary of symptoms
• Avoid sugar-free gum and hard candies—the sweeteners can cause extra gas while chewing gum and sucking on candy cause one to swallow excess air.

Remember that everyone experiences belching, bloating, and flatulence at one time or another. It’s normal! However, if it is interrupting your life, causing you frequent, recurring discomfort; or causing you to feel generally unwell, it is time to seek professional help.

Granite Peaks Gastroenterology Specialists are available to help you find answers and stop these uncomfortable and embarrassing symptoms. Call us today at (801) 619-9000 to make an appointment.

How to take care of your internal plumbing as you age

Posted on April 28, 2022April 28, 2022 by fuelmarketing

As we age, changes in our body often require change in our diet – not only what we eat, but how we eat it. A registered dietitian discusses some tips to keep your digestive health at its best as you age.

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TIP: Eat your food hot

By Ginger Bailey, RDN CD

Originally posted on 11/24/2020
Updated on 4/28/2022

My kids get very upset when we use the “O” word. According to them, the word “old” is a dirty word and adults are not allowed to refer to themselves as such – especially not their grandparents!

No one likes to think about getting older or to even admit that they are aging. Unfortunately, “Time” cannot be denied and our bodies change as we age. The good news is that if we understand how our body changes and what we can do to support it, we can make age a state of mind more than a state of body. In essence, we can become wiser rather than simply older. (Shh, don’t tell my kids I said the “O” word!)

One of the best ways to keep our bodies fit and active as we age is to take care of our “internal plumbing.” I’m referring, of course, to our digestive system.

As we age, our gut becomes a little less efficient at extracting nutrients from the food we eat. Every vitamin and mineral we eat goes through a complex pathway to convert from food to a form the body can absorb. Some of these pathways are more complex than others. Generally speaking, the more complex the pathway, the sooner we tend to lose the ability to adequately absorb the nutrients we need. So, let’s talk about a few of these nutrients, as well as some things you can do to slow down the aging process and take good care of your internal plumbing.

Vitamin B12

Let’s start with Vitamin B12. This nutrient is an important powerhouse. It’s critical for your body to be able to convert the food you eat into energy. It also has one of the most complex absorption pathways. A low level of B12 is one of the most commonly-found deficiencies in seniors, and can lead to a condition called pernicious anemia. Pernicious anemia can cause significant fatigue, headaches, and paleness.

As people age, they often start feeling more fatigued and just chalk it up to “old age”. In some cases, it may be a nutrient deficiency that can be corrected. This is not the only deficiency that can cause fatigue, but it is one of the more common ones because B12 is difficult to absorb in any case. People that have had bariatric surgery or any surgery involving the stomach or small intestines are at high risk of being B12 deficient.

Fortunately, vitamin B12 levels can be checked. If you are experiencing any of the above symptoms, or are concerned, you can work with your doctor to have your blood levels analyzed and decide on the best support options for your body.

Trace Minerals

Trace minerals include calcium, magnesium, iron, zinc, selenium, copper, phosphorus, potassium, manganese, and a few others. These minerals are responsible for many things, including but not limited to: bone health, nerve conduction, and immune health. Most of these nutrients are absorbed in the first part of your small intestine, but many compete for the same absorption pathways. That can make it difficult for your body to digest all of them equally. For anyone who has had a surgery that altered the anatomy of their GI tract – and this is the case for many people – this can be an issue.

Also, as time goes on, it is common for our bodies to produce fewer digestive enzymes. Digestive enzymes help our bodies break down food and easily absorb nutrients, so this process can become less effective as we age.

There is a very simple solution to this problem. Eat slower! You see, chewing your food more can help with this. The more work your teeth do, the less your stomach has to do. There are also enzymes in your mouth that start breaking down food. So, if you chew your food more thoroughly, there is a higher likelihood that you are going to get more nutrients out of it. If your teeth are not in good condition, or chewing is difficult for some reason, then blending or pureeing food can also be helpful.

Fiber

Most Americans don’t get adequate fiber in their diets. This causes a myriad of problems. Consequences of inadequate fiber intake include:

Higher risk of cancers
More issues with constipation and diarrhea
Poor immune function
Higher cholesterol levels
More GI disturbances
Higher inflammation
Poor blood sugar control

The best sources of fiber are whole grains, vegetables, fruits, and legumes. If you aren’t getting enough fiber in your food, adding a fiber supplement can be helpful.

Age and Appetite

Many people find that their appetite decreases as they get older, often because of a reduced sense of taste. It can be harder to get those appropriate nutrients we just talked about when your appetite decreases and your sense of taste fades. So, what do you do then? Most people resort to dumping extra salt on their food so they can taste it. While that theoretically can work, it is not the best solution for your overall health. Instead, let’s talk about how to spice things up a bit!

(If you are thinking, “um…my digestive tract can’t party like I’m in my twenties anymore,” worry not. There are seasonings and spices that are both safe and healthy for your gut.)

Garlic is a very versatile flavor that is potent and has positive health benefits. Now, garlic can be an issue for some people with severe irritable bowel syndrome. For most people though, garlic is a great way to add a depth of flavor to food and make it more exciting to eat. Garlic pairs nicely with other flavors. It can also help decrease inflammation and support immune function.

Basil is another powerful herb that packs a lot of punch with flavor. It is very gentle on the digestive tract, but strong enough to add flavor to many types of foods. There are many varieties of basil. It is generally easy to grow even year-round inside your home. You can add a little or a lot depending on how much you like.

Rosemary is another one of my flavor rock stars. It tastes great with pork and many vegetables. It can really elevate a dish from “fine” to “delicious.” This one is also gentle on your insides, while allowing your taste buds to dance a bit.

There is one flavor source that requires a bit of caution. Anything containing capsaicin (the source of the heat you feel when you eat a spicy pepper) can be irritating to the digestive tract. While many people enjoy the heat, capsaicin has a higher tendency to cause digestive discomfort. Spices that contain capsaicin include, but are not limited to:

Red pepper flakes
Cajun seasoning
Some taco seasonings
Chipotle/jalapeno peppers

It doesn’t mean you can’t ever use these flavors, but you may want to use them in smaller quantities since they are potent and have the potential to irritate your gut.

Here’s another tip: Eat your food hot!

Warmer foods tend to be more aromatic. Much of our sense of tastes comes from our sense of smell. Foods that have a stronger smell are also usually easier to taste. If you find that tasting your foods is a problem, keeping your sinuses clear will help. Eating a hot sandwich might be easier to taste than if you ate it cold, for example. Or having cooked vegetables rather than raw.

Hopefully a few of these little tricks will help you enjoy your food longer and keep your body working at top notch for as long as possible. And maybe help you avoid feeling the “O” word for as long as possible. Happy eating!

Do you have concerns about your gastroenterological health? Granite Peaks Gastroenterology can help! Click here to request your appointment with one of our gastroenterologists today!

Diet Management for IBS

Posted on June 8, 2020October 20, 2020 by fuelmarketing

How watching what you eat can make your bowels a little less irritable

by Ginger Bailey, Registered Dietitian/Nutritionist

If you have been diagnosed with Irritable Bowel Syndrome (IBS) you know how troublesome, and sometimes debilitating, the symptoms can be. IBS can be difficult to diagnose since symptoms may present differently from person to person. Some may have diarrhea while others struggle more with constipation. For others, nausea and bloating are more severe.

The good news is that better dietary management can often reduce symptoms and improve quality of life. Finding what works for you can be tricky as dietary management varies based on each person and their symptoms. However, there are a few general recommendations that can be helpful.

Keep a food/symptom log. This is the best way to find out which foods trigger your symptoms and which help alleviate them. Because people often don’t eat one food at a time, it can be difficult to pinpoint if there is a particular food that seems to cause issues for you. Make notes about any symptoms that appear within an hour of eating. Over the course of time, it will become easier to find correlations.Also, if your symptoms ever flare up, make note about other things happening at the time. Are you feeling more stress than usual? Did you just have a difficult conversation with someone? Did your schedule change suddenly and unexpectedly? Did you go to a new place? Keeping a log will help you learn more about how your body operates, and by extension, how you can best take care of it.
Limit the amount of processed foods and artificial ingredients you eat. The human body does not deal well with artificial sugars, fats, colors, etc. These foods may also have a negative impact on the microflora of your gut. The balance of bacteria in your GI tract is very important! Eating a lot of processed foods can disrupt that balance and worsen GI issues, in addition to being generally detrimental to your system. Instead, look for foods with ingredients you recognize. You can never go wrong with fresh fruits and vegetables, and whole, unprocessed foods.
Learn what activities help you discharge your stress. While the demands of daily life mean it’s often not possible to eliminate, or even decrease, your stress, there are ways to better manage it. There are ways of discharging stress and other negative feelings.Why is this important? Your gut has tons of nerves in it! Research has found that stress can wreak havoc on the nerves. If we don’t let go of our “emotional baggage that built-up tension can affect the nerves in your GI tract.
Enjoyable activities like exercise, meditation, reading, gardening, hobbies, art, and listening to music are all great ways to help dissipate pent-up energy and frustration.

To manage specific symptoms, try these suggestions:

Constipation

Constipation means stool moves too slowly through the large intestine, resulting in hard, painful bowel movements. To avoid this:

Get adequate amounts of fluid and fiber
Avoid excessive starches (bread, pasta, baked goods)
Talk to with your gastroenterology specialist about probiotics
Eat plenty of fruits and vegetables
Keep a food/symptom diary to log your body’s reaction to different foods.

You can also talk with your gastroenterology specialist about taking probiotics. These can be helpful for maintaining a good balance of healthy bacteria in your intestines. Eating plenty of fiber also helps provide more bulk to help your colon move food along more consistently, but always increase fiber intake gradually. Increased fluid intake is necessary when increasing fiber intake to prevent worsening constipation.

Diarrhea

People with diarrhea have the opposite problem of those with constipation – their stool is moving too quickly. In this case, starchy foods and foods high in soluble fiber tend to help bind extra fluid. For example, oatmeal has quite a bit of soluble fiber. Adding a soluble fiber supplement, like Benefiber®, may also be useful, but as with any fiber, add it to your diet gradually!

Gas

Some foods naturally produce more gas, but the situation is worsened for those with IBS. These foods may include beans, lentils, potatoes, eggs, asparagus, broccoli, Brussels sprouts, cabbage, onions, garlic, lactose (found in milk), soft drinks, artificial sweeteners, and some whole grains. Many of these foods are good for you in other ways, though, so you shouldn’t eliminate them from your diet entirely. Instead, practice moderation and note in your food log if a specific food is giving you trouble.

Wheat can be a common trigger for symptoms. It may be worth eliminating wheat for a period to see if it improves symptoms. Also, suddenly increasing your fiber intake will tend to cause more gas and GI distress. Consuming excess amounts of insoluble fiber in particular can also do this.

Again, gas isn’t an excuse to not eat your vegetables! Just try to avoid eating a lot of gas-producing foods together in one day if you are already struggling excess gas.

Nausea

Personally, this is usually my first indicator that something I ate didn’t agree with me. It typically starts before any of the other symptoms. So, I will immediately make note of anything I ate at that particular meal or snack. (Once again, keep a food/symptom log. It really is a powerful tool!)

If you experience nausea, ginger and mint are both excellent natural remedies. Ginger or mint tea – hot or cold – can also work. There are also ginger mints you can buy from many grocery stores that are helpful for nausea. Fresh ginger also adds a great flavor to meals.

Summary

As a dietitian, I have personally struggled with IBS and I know how challenging it can be. That said, because I listened to my body, I have found ways to keep my symptoms manageable and I feel good most of the time. I have found through my own personal experience, as well as that of my clients, that the most important thing is to listen to the cues your body gives you. Our body knows what it needs – we just don’t always pay attention. Do your best to create a positive environment surrounding eating. When people struggle with GI issues, food often becomes something they don’t even want to think about anymore. If your brain creates negative associations with food, it can make the situation worse. Try to make the experience of eating as positive as possible. Eat with family, listen to uplifting music while you eat, or even eat at a favorite location. Anything you can do to make eating a positive experience can be helpful. After all, good food is truly one of life’s greatest pleasures!

Think of it this way. Imagine it’s a Monday, and all day long you find yourself having to deal with things you’d rather not deal with. You get stuck in traffic, your desk piles up at work, the weather’s awful, and when you get home, you see that no one bothered to clean up the kitchen. You’d probably feel pretty irritable, wouldn’t you?

Your body works the same way. When we subject our GI tract to unhealthy food – or food our body simply doesn’t tolerate well – it reacts exactly the same way we do: It gets irritable. By following the steps above, you can make your gut a lot happier, making you a lot happier in the process.

Adjust Expectations During Shelter in Place

Posted on April 9, 2020October 19, 2020 by Granite Peaks

Granite Peaks GI Staff

4/09/2020

Part of the frustration that can come with this sort of change to our normal daily life is sustaining our normal expectations while living and working in an abnormal way. This goes for how we work, how we eat, how we exercise, how we create, sleep and plan. The secret to avoiding some of the frustration is to adjust our expectations – for now.

If you’re working reduced hours whether at home or at your place of work, you are likely able to adjust your schedule and some expectations. This is a great opportunity to build some new, positive habits by planning ahead to use your time wisely and productively.

Awaken at the same time. Try to keep it around your usual time so there won’t be a big adjustment when you go back to work full-time.
Use your commute time. If you aren’t commuting, use the extra time to ease into your morning with 10-30 minutes of exercise, meditation, reading, and a healthy breakfast. No, you can’t go to the gym right now, but you can figure out some ways to keep up some of your routine from home. Meditation (look online for free options for guided meditation) can help create mindfulness and ease anxiety during this unusual time.
Take a break from at-home work. If you’re used to grinding through the workday without breaks, rethink that. A break gives your mind and body the reprieve it needs. Those with children or family at home can use the time to reconnect with them and enjoy each other’s company. Have lunch outdoors on good-weather days to recharge and ready yourself for the afternoon’s work. That’s better than the work lunchroom any day!
Adjust expectations of your kids. If you have kids, you know this time has been tough on them and on you. They’re not in their normal routine, they can’t see their friends, they can’t even go to the playground at the park. That’s a recipe for tension and mayhem. So, you’re it! You’re in charge of their schooling, daycare, mind-filling and energy-burning activities – while you’re trying to work from home. Create a schedule of activities including learning, chores, creative play, outdoor and nap/quiet times. If you need to discuss adjusted work hours/expectations with your supervisor to accommodate this unusual situation, do it. Check the Workforce Services website if you have questions about your rights or eligibility for benefits surrounding daycare and your work hours.
If your work hours are over earlier than usual, plan to get outdoors for some exercise and fresh air, start a project you’ve been waiting to do, catch up on correspondence and reading, and remember to play. Make a list and schedule certain days or times for certain activities. Planning is key to making the most of your time at home the same way it is at work.
Eat healthy. Now is the time to learn how to properly meal-plan and shop for only those things you need to make your week’s meals. It’s not the time to indulge (too much) with unnecessary, unhealthy items. There are online planning tools to help you build a healthy, delicious week of meals. Remember to wear your facemask at the store and wash your hands thoroughly before and after you shop.
Adjust your TV consumption. Don’t overdose on news about the pandemic. Get one daily news report and move on to entertaining or educational programming. Choose the time you will stop watching television and begin winding down for a reasonable bedtime to allow for 8 hours of rest. Rest is an important part of staying healthy. This is an easy one – you can do it.
Shut off the TV. Even better! Now is a great to play games, work puzzles or work on projects alone or with your family. This is an adjustment that you can enjoy living with.

For those with digestive health issues, be sure to stock up on the items that keep you feeling healthy and keep your digestive system running smoothly. Whether you have celiac disease, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), or other digestive health issues, be sure you are taking the precautions necessary to stay well. If you are immunocompromised, do what you can to minimize your risk of contracting the virus. Plan daily exercise and dietary goals for staying well.

Know that your providers at Granite Peaks Gastroenterology are available to you, even during the COVID-19 situation. We have telehealth appointments available that let you connect with your GI provider from the safety and privacy of your home. It’s easy to set up, convenient and safe!

For those who have symptoms that may necessitate an in-person appointment, our clinic is making it safe for you to come in to see us. We are scheduling patients to allow for social distancing, pre-screening patients, performing extra cleaning steps between patients and wearing personal protective equipment.

For now, we are all adjusting expectations and actions to stay well and avoid either contracting COVID-19 or spreading it to others, and it’s working. Keep up the good work, Utah! We wish everyone safe and healthy days ahead.

Eating Healthy for Your GI Condition

Posted on May 21, 2019September 12, 2019 by fuelmarketing

By Granite Peaks Gastroenterology

Eating a healthy diet is one of the best ways to give your body the right kind of fuel for good health and healthy weight management. In general, maintaining a healthy weight puts less pressure on the gastrointestinal (GI) system, decreasing symptoms for many GI conditions.

However, some healthy foods can cause increased symptoms for individuals suffering with Gastroesophageal Reflux Disease (GERD), Irritable Bowel Syndrome (IBS), Celiac disease and Inflammatory Bowel Disease IBD like ulcerative colitis and Crohn’s disease. Raw vegetables, whole wheat or grains, and high-fructose fruits can aggravate the gut, increasing unpleasant symptoms because the body may have a harder time digesting such foods.

The goal is to eat the healthiest diet that agrees with your system to obtain the best nutrition while avoiding uncomfortable symptoms. Good nutrition supports the entire body and balancing a nutritious diet within the limits of your body’s digestive tolerance levels will achieve good health and a good GI state.

If you, or someone you know, has gastrointestinal issues, consult one of the gastroenterology specialists at Granite Peaks Gastroenterology in Sandy or Lehi. If you have a condition that may require adjustment to your diet, they can help you make the right choices to live a healthy life without the discomfort of GI symptoms.

Are you Lactose Intolerant?

Posted on January 25, 2018February 2, 2018 by

OVERVIEW
Lactose is the sugar found in milk and dairy products such as cheese and yogurt. After eating dairy products that contain this sugar, usually lactase, a digestive enzyme of the small intestine, helps to breakdown this complex sugar into two simple sugars, glucose and galactose. These simple sugars are then absorbed in the small intestine and ultimately reach the blood stream where they act as nutrients. The enzyme lactase is located in the lining of the small intestine known as the intestinal villi.

In addition to milk and dairy products such as ice cream, yogurt and cheese, lactose can be found in bread and baked goods, processed breakfast cereals, instant potatoes, some soups and non-kosher lunch meats, candies, dressings and mixes for pancakes and biscuits. Lactose is also the sugar found in breast milk and standard infant formulas. Therefore almost all babies are able to digest and absorb this sugar and it serves as their primary dietary sugar.

SYMPTOMS
Because lactose is not digested properly in the small intestine of individuals who are lactose intolerant, it passes whole into the large intestine or colon. Upon reaching the colon it is broken down by the normal colon bacteria. This breakdown results in the production of carbon dioxide and hydrogen gases. The gas production can lead to the following common symptoms:

• Abdominal distension and pain
• Excess burping
• Loud bowel sounds
• Excess gas and diarrhea following ingestion of lactose.
• Watery and explosive bowel movements
• Urgency with bowel movements, which means that children feel that they have to get to the bathroom immediately or they will have an accident.

The symptoms of lactose intolerance can start during childhood or adolescence and tend to get worse with age. The severity of symptoms is usually proportional to the amount of the milk sugar ingested with more symptoms following a meal with higher milk sugar content.

Although eating lactose-containing products will result in discomfort for someone who is lactose intolerant, they are not at risk of developing more serious intestinal disease because of long-term lactose malabsorption. The only exception to this would be for babies who are born with primary lactase deficiency or children with secondary lactase deficiency as discussed below.

CAUSES
Primary Lactase Deficiency: This condition is very rare and occurs when babies are born with a deficiency or absence of the enzyme lactase. Babies inherit this condition by getting one gene that causes this problem from each of their parents, even though both parents may be lactose tolerant. These babies require a specialized formula with another type of sugar such as sucrose (present in table sugar), which they are able to digest.

Secondary Lactase Deficiency: The most common cause of temporary lactose intolerance in infants and young children is infection that affects the gastrointestinal tract and can damage the lining of the small intestine.

Rotavirus and Giardia are two common organisms that cause damage to the surface of the small intestine resulting in temporary lactose intolerance. Older infants and young children will commonly be infected by a rotavirus. The symptoms of rotavirus infection symptoms include vomiting, diarrhea (frequent, watery stools), and fever. Giardia is a parasite that is found in well water and fresh water from lakes and streams. Treatment of giardia infection with antibiotics will resolve the lactose intolerance.

Secondary lactase deficiency can also be due to Celiac disease, which is intolerance to gluten, the protein found in wheat, rye, barley and other grains. Crohn’s disease, an inflammatory condition that can affect any part of the gastrointestinal tract, can lead to secondary lactase deficiency as well. Once each of these conditions is treated, the lactase deficiency will resolve. The lactose intolerance usually resolves within three to four weeks when the lining of the intestines returns to normal.

Acquired Lactase Deficiency: Many individuals acquire lactose intolerance as they get older. It is estimated that approximately one-half of adults in the United States have acquired lactase deficiency. This condition is due to a normal decline in the amount of the enzyme lactase present in the small intestine as we age. Although lactose is an important part of the diet in infants and young children it represents only 10% of the carbohydrate (sugar) intake in adults. However, individuals who are lactose intolerant may not be able to tolerate even small amounts of this sugar in their diet.

Lactose intolerance occurs more frequently in certain families. One of the most important factors affecting the rate of developing lactose intolerance is an individual’s ethnic background. Approximately 15% of adult Caucasians, and 85% of adult African Americans in the United States are lactose intolerant. The rate of lactose intolerance is also very high in individuals of Asian descent, Hispanic descent, Native Americans and Jewish individuals.

DIAGNOSIS
Lactose intolerance is diagnosed by a simple test called a hydrogen breath test. After an overnight fast before the test, an individual breathes into a bag and then drinks a specified amount of the milk sugar in the form of a syrup. In adults this corresponds to the amount of milk sugar in a quart of milk. Subsequent breath samples are taken for up to three hours. The breath that they exhale into the bag is analyzed to determine its hydrogen content. During the course of the test individuals who are lactose intolerant will have an increase in the amount of hydrogen that they exhale. If the values for hydrogen increase above a certain value, the diagnosis of lactose intolerance is made. Patients who are lactose intolerant may also develop their typical symptoms during the test.

In younger children or in children who cannot tolerate the breath test, removal of lactose from the diet and possible supplementation with lactase can be done for 2-4 weeks to see if this improves the symptoms.

Treatment
The best treatment of lactose intolerance is a combination of dietary modification and taking a supplement to aid in digestion of lactose. Individuals who are lactose intolerant should meet with a dietician to review the sources of lactose in their diet. Some reduction in the daily lactose consumption is usually required. When an individual is going to be eating a food that contains lactose they should take a commercially available non-prescription lactase supplement at the time of lactose ingestion. This type of supplement can be taken throughout the day whenever lactose is ingested. Some individuals will be less lactose intolerant and therefore will be able to tolerate comparatively larger amounts of lactose. Alternatives to milk for lactose intolerant individuals include products such as soy milk. If an individual is restricting their milk/ dairy intake it is important to ensure adequate supplementation of calcium and Vitamin D in the diet. This is especially important for pediatric patients and women.

Recommended daily calcium intakes:
1-3 years of age: 500 mg
4-8 years of age: 800 mg
9-24 years of age: 1300 mg
Age 25 and above: 800-1000 mg
Pregnant and nursing women: 1200 mg

Author(s) and Publication Date(s)

Marsha H. Kay, MD, The Cleveland Clinic, Cleveland, OH, and Anthony F. Porto, MD, MPH, Yale University/Greenwich Hospital, Greenwich, CT – Updated December 2012.

Marsha H. Kay, MD, The Cleveland Clinic, Cleveland, OH, and Vasundhara Tolia, MD, Children’s Hospital of Michigan, Detroit, MI – Published September 2004.

Diagnosing and Treating
Irritable Bowel Syndrome (IBS)

Posted on April 11, 2017April 18, 2019 by J. David Schmidt

By J. David Schmidt, M.D.

Irritable Bowel Syndrome (IBS) represents a group of symptoms that cause a significant number of people to seek medical attention every year. It is estimated that 10-15% of North Americans suffer from IBS, and it is by far the most commonly diagnosed gastrointestinal condition. Irritable Bowel Syndrome is the second most common medical reason to miss work, after the common cold.

The specific symptoms of IBS vary widely among those who suffer from the condition, but the hallmark is a pairing of chronic abdominal pain and altered bowel habits. The abdominal pain may range from mild to severe. It may be associated with factors such as stress and eating. The bowel changes may include diarrhea, constipation, or alternating back and forth between both. There is also a sub-type called post-infectious IBS that develops after a gastrointestinal infection. According to the most current literature, IBS is defined as recurrent abdominal pain at least one day per week in the last three months, on average, and associated with two or more of the following:

- • Improvement with bowel movements

- • Associated with a change in stool frequency

• Associated with a change in stool form or appearance

The following symptoms are NOT consistent with IBS and are reasons to see a gastrointestinal specialist:

- • More than minimal bleeding

- • Weight loss

- • Iron deficiency anemia

- • Nocturnal symptoms

• Family history of colorectal cancer, inflammatory bowel disease, or Celiac sprue

The initial treatment of Irritable Bowel Syndrome includes dietary modifications such avoiding foods that contain lactose and gluten, as well as gas-producing foods. A low FODMAP diet is also a consideration as initial therapy. Pharmacologic (drug) therapy for IBS depends upon the troublesome symptoms. IBS with constipation is treated with increased dietary fiber as well as psyllium and prescription laxatives. IBS with diarrhea can be treated with OTC anti-diarrheal medications such as Imodium. Other options include prescription medications such as bile acid sequestrants and serotonin receptor blockers. Gas and bloating can be treated with antispasmodic medications. or even GI-selective antibiotics.

Due to the many different symptoms of IBS, there is a wide range of treatment options including dietary, behavioral, and medical therapies. It is important to discuss your symptoms and family history with your medical provider so that appropriate evaluation may take place. Ultimately, IBS is a very common but treatable condition.

Learn more about Irritable Bowel Syndrome (IBS) or click here to schedule an appointment with a Granite Peaks gastroenterologist.

More Options To Treat Irritable Bowel Syndrome

Posted on June 23, 2016September 15, 2016 by fuelmarketing

By Peter Loftus

View Original Article

People suffering from a common but tough-to-treat gut disorder called IBS are discovering a growing set of treatment alternatives.

The U.S. Food and Drug Administration has approved two new drugs in the past year for the disorder, known as irritable bowel syndrome, which involves chronic diarrhea, constipation or both, along with abdominal cramping. It is estimated to affect about 12% of Americans, more often women than men and typically in people younger than 45, according to the Mayo Clinic.

Meanwhile, a diet dubbed “Low Fodmap,” which originated in Australia more than a decade ago, has spread in the U.S. in recent years. It is gaining acceptance from gastroenterologists and dietitians as some small clinical trials bolster evidence of its effectiveness in reducing IBS symptoms. The diet eliminates or reduces foods with certain types of sugars that have been found to trigger symptoms.

“I definitely think the options are better and that patients with mild symptoms can do better,” says Dr. Lin Chang, director of the digestive health and nutrition clinic at UCLA‘s David Geffen School of Medicine. “I think the question is, what treatment do you use in what patient?”

Unlike more serious gut conditions, such as Crohn’s disease or ulcerative colitis, IBS doesn’t alter bowel tissue or put patients at increased risk for colorectal cancer. But it causes pain, embarrassment and anxiety in sufferers, who often limit their activities only to places where a toilet will be close by.

“It’s really common, and I think it’s underappreciated in terms of the burden it creates for affected individuals,” says Dr. William Chey, a professor of internal medicine specializing in gastrointestinal disorders at the University of Michigan.

Older treatment options have included antispasmodic drugs like dicyclomine and low-dose antidepressants such as amitriptyline. Dietary approaches have included adjustments to fiber intake. But these options don’t work for everyone.

In May 2015, the FDA approved two new drugs for treatment of IBS in which diarrhea is predominant: Viberzi, made by Allergan PLC, and Valeant Pharmaceuticals InternationalInc.’s Xifaxan. For IBS with constipation, the FDA approved Allergan’s Linzess in 2012.

Dr. Leslie Yang, a University of Chicago gastroenterologist, says the new drugs have shown some level of efficacy in clinical trials, but it can take some trial and error to figure out which will work best for an individual patient. “It’s more of an art than a science,” she says.

The new drugs aren’t without side effects. Viberzi can increase the risk for muscle spasms near the digestive tract that can lead to inflammation of the pancreas. Dr. Chang of UCLA says doctors should avoid prescribing it to people who abuse alcohol.

A dietary approach to easing that burden has gained steam in the U.S. as physicians like Dr. Chey listen to patients who would rather avoid taking a prescription drug, he says. The University of Michigan, University of Chicago and Stanford University are among the academic medical centers that have embraced the low Fodmap diet as an option for patients. Some have hired dietitians specializing in gastrointestinal disorders to help guide patients.

Fodmap is an acronym for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols”—a group of sugars and other food ingredients poorly absorbed in the gut. Patients are advised to restrict eating foods with high amounts including asparagus, apples, cow’s milk and certain beans. They are encouraged to eat foods with lower amounts, including zucchini, bananas, certain cheeses and gluten-free breads and cereal.

“This helps to at least minimize the diarrhea, minimize the gas and bloating,” says Lori Welstead, a University of Chicago dietitian. “So this can really help with the quality of life for patients.”

Researchers at Monash University in Melbourne, Australia, developed the low-Fodmap diet and have conducted clinical trials to test its efficacy. In a 38-person study, those on the low-Fodmap diet had reduced gastrointestinal symptoms versus those on a typical Australian diet, according to results published in the medical journal Gastroenterology in 2014.

In a U.S. study of 33 children with IBS conducted by researchers at Baylor College of Medicine in Houston, a low-Fodmap dietreduced the frequency of abdominal paincompared with a traditional American diet, according to results published in Alimentary Pharmacology and Therapeutics last year.

Morgan Blenkhorn, a 21-year-old student at Grand Valley State University in Allendale, Mich., says the low-Fodmap diet has given her relief from severe IBS symptoms. She first started having problems after a food-poisoning incident in high school. Her anxiety about having to use the bathroom frequently kept her from many activities including graduation parties, she says.

She discovered the low-Fodmap diet after visiting Dr. Chey at the University of Michigan in 2013, and it has vastly reduced her symptoms, she says. Last summer she taught English in the Netherlands and made a side trip to Germany—something she would never have considered when her IBS was worse.

“It changed my life completely,” she says. “I don’t think that I could have even gotten this far in college without drastic change.”

A caveat with the low-Fodmap diet: There is emerging evidence that it alters the diverse population of microbes in the gut. This could have long-term implications, because some gut microbes are believed to have health benefits. A Monash-sponsored study of 33 people found that the low-Fodmap diet reduced abundance of bacteria in the gut, according to results published in the medical journal Gut in 2014.

Emma Halmos, a dietitian at Monash who helped conduct the study, says more research is needed to show whether the microbial alterations can harm health. She says it underscores the need for healthy people to avoid the low-Fodmap diet, and for patients on the diet to try to reintroduce specific foods if they don’t trigger symptoms.